Combined use of posterior unilateral open-door laminoplasty and leverage fixation for treatment of multi-segmental cervical spondylotic myelopathy / 军事医学

Objective To evaluate the clinical efficiency of posterior unilateral open-door laminoplasty and leverage titanium plate internal fixation in the treatment of cervical spondylotic myelopathy ( CSM ) with multi-segmental spinal stenosis.Methods Between Mar 2011 and May 2015, 25 patients with multi-segmental CSM with multi-segmental spinal stenosis were treated by posterior unilateral open-door laminoplasty and leverage fixation .There were 16 males and 9 females, whose mean age was 60.6 ±9.9 years during the surgery.The change of clinical symptoms and signs was recorded during follow-up,and they all received X-ray and MRI.In all the patients, the preoperative and postoperative neurological function, the cervical curvature,cervical vertebra tube volume and axial symptoms were measured , recorded and analyzed. There was statistically significant difference (P<0.05) in the mean Japanese Orthopaedic Association (JOA) score, and Visual Analogue Scale ( VAS) .Results All the 25 patients were followed up for more than 6 months ( 6-24 months ) .No symptoms of C5 nerve root were found in our series .According to the JOA score and VSA score ,the neurological functions of each patient were significantly improved .The preoperative JOA score was 10.16 ±1.35 and the improvement rate 61.24%. There was statistically significant difference between the preoperative VSA score and the postoperative one (6.68 ±1.12 vs 2.32 ±0.84) ( P<0.05).The preoperative and postoperative meansurement of the spinal vertebrai canal diameter was (9.22 ±2.01) and (15.64 ±2.08) mm, respectively,so there was statistically significant difference (P <0.05), indicating that the cavical spinal canal was increased after operation .Conclusion Leverage titanium plate internal fixation can effectively help maintain the expanded vertebral canal after unilateral open -door laminoplasty ,reduce the incidence of postoperative axial symptoms , and maintain the cervical physical curvature .

Stiffness changes in short-segment spine after destabilizing by using the Distraction Reduction Fixation System / 中国组织工程研究

BACKGROUND:Self-made Distraction Reduction Fixation System is characterized by Distraction Reduction Fixation functions,which can completely fuse to the design of steel plate,and by no need to provide many surgical instruments,by reduction of bleeding and trauma.OBJECTIVE:To test changes in the stiffness of porcine short spinal segments in integrity and following destabilizing and internal fixation of the Distraction Reduction Fixation System.DESIGN,TIME AND SETTING:The control observation experiment was performed at the Laboratory of Biodynamics,Institute of Onhopedics,General Hospital of Chinese PLA from December 2004 to December 2005.MATERIALS:Twelve fresh porcine lumbar spines(T11-S2 segments)were bought from a market.Upper and lower segments were crossed and inserted with Kirschner wire to make porcine spine samples of the L1-7 segments.METHODS:Stiffness of intact samples was recorded during forward-bending,backward-bending,lateral-bending and axial rotation.Intervertebral discs,facet ioints,anterior and posterior longitudinal ligaments were removed to loose the spine.Stifrness of each motion was measured.Stiffness tests were repeated again after internal fixation on short segments using Distraction Reduction Fixation System.MAIN OUTCOME MEASURES:Stiffness in the intact,unstable and internal fixed spines during each motion.RESULTS:The stiffness iu unstable porcine spine were significantly lower than those in intact porcine spine(P<0.05),but the stiffness after internal fixation was significantly higher than in unstable porcine spine(P<0.05).No significant difference was detected in stifiness during forward-bending,lateral-bending and axial rotation(P>0.05)except that it was significantly higher during backward.bending after internal fixation compared with the intaet spine(P<0.05).CONCLUSION:Biodynamics confirms that the stiffness in short-segment fixation porcine after using Distraction Reduction Fixation System is markedly increased than in unstable porcine spine,except during backward-bending,which is comparable with that in intact porcine spine.

Comparative Study of Paravertebral Muscles in Congenital Scoliosis and Idiopathic Scoliosis Patients / 中国康复理论与实践

@#Objective To identify the role of paravertebral muscles in the pathogenesis of scoliosis.MethodsParavertebral muscles were gotten from the 37 patients(12 congenital scoliosis patients and 25 idiopathic scoliosis patients) during the operations.Cryostat sections were cut by 10 μm nd stained with H&E,m-GT,NADH-TR,ATPase.ResultsMyogenic changes,incuding muscle fibrosis,fiber necrosis,etc,were common in paravertebral muscles of scoliosis patients,however regenerating fibers were quite rare.Diffuse fibrosis and remarkablely disorganized fiber directions presented in most of congenital scoliosis patients,while focal fibrosis without necrosis in most of idiopathic scoliosis patients.Neurogenic changes were found in one congenital scoliosis patient and 4 idiopathic scoliosis patients,however four of the five patients had undergone orthopedics.Thickened capsule wall of muscle spindles and connective tissue infiltration in muscle spindles were found in both kinds of scoliosis.ConclusionThere are some differences on pathological changes of paravertebral muscles between congenital scoliosis and idiopathic scoliosis,which indicates that paravertebral muscles may play a special role in the pathogenesis of idiopathic scoliosis.

Comparative Study of Paravertebral Muscles in Congenital Scoliosis and Idiopathic Scoliosis Patients / 中国康复理论与实践

@#Objective To identify the role of paravertebral muscles in the pathogenesis of scoliosis.MethodsParavertebral muscles were gotten from the 37 patients(12 congenital scoliosis patients and 25 idiopathic scoliosis patients) during the operations.Cryostat sections were cut by 10 μm nd stained with H&E,m-GT,NADH-TR,ATPase.ResultsMyogenic changes,incuding muscle fibrosis,fiber necrosis,etc,were common in paravertebral muscles of scoliosis patients,however regenerating fibers were quite rare.Diffuse fibrosis and remarkablely disorganized fiber directions presented in most of congenital scoliosis patients,while focal fibrosis without necrosis in most of idiopathic scoliosis patients.Neurogenic changes were found in one congenital scoliosis patient and 4 idiopathic scoliosis patients,however four of the five patients had undergone orthopedics.Thickened capsule wall of muscle spindles and connective tissue infiltration in muscle spindles were found in both kinds of scoliosis.ConclusionThere are some differences on pathological changes of paravertebral muscles between congenital scoliosis and idiopathic scoliosis,which indicates that paravertebral muscles may play a special role in the pathogenesis of idiopathic scoliosis.

Features of Atlantoepistrophic Imaging Examination in Patients with Vertigo of Cervical Syndrome / 中国康复理论与实践

@#ObjectiveTo investigate atlantoepistrophic imaging features of patients with vertigo of cervical syndrome.Methods74 patients with vertigo of cervical syndrome were checked by photographs of cervical vertebrae of A-P position, lateral position and mouth open position, some patients were checked by CT three-dimensional reconstruction and/or MRI vertebral arteriography.ResultsImaging examination of these patients showed that physiolgical curvature of cervical vertebrae became straightened, width of both lateral masses of atlas was inequality, space of both lateral masses of atlas to odontoid process of vertebra dentata was also inequality, and inferior articular surface of lateral mass was not parallel with superior articular surface of axis. The CT could display the side displacement and anterior or posterior rotation of lateral masses of atlas. The cervical MRI vertebral arteriography could display the effect of side displacement and rotation of lateral masses of atlas on vertebral artery. If side displacement or rotation of vertebral artery occurred, the diameter of artery decreased.ConclusionThe diseased region of vertigo of the cervical syndrome is the atlas and axis, especially the side displacement and anterior or posterior rotation of the atlas.

Analysis on mechanical property of remedy for scoliosis by PRSS / 中国矫形外科杂志

[Objective] Scoliosis with wedging of vertebra and open-up disc space over convex side can be reversed when PRSS(plate-rod system for scoliosis)was applied.In order to study the mechanical properties of the remedy for the scoliosis by PRSS,the photoelastic test was performed.[Method] The model that consists of five vertebra bodies and four intervertebral discs was built with aluminum and polycarbonate,thus the situation of low-grade scoliosis was simulated.The axial stress was loaded 0 kg,5kg,10 kg,15 kg,20 kg respectively,and the lateral side load was 0 kg,3 kg,6 kg,9 kg,and 12 kg respectively over the spinal column.According to the factual situation,the in-situ stress was measured by using photoelastic and strain gage method.ANSYS9.0 method was also applied to simulate the experiment process and evaluate the reliability of measurement.[Result]When PRSS was placed in,compressive stress was found to exert on the convex side whereas tensile stress was found on the concave side of the curvature,thus modulating bony growth of spinal vertebra,resulted in spinal column realignment.[Conclusion]The PRSS is an effective device to treat the scoliosis of the patients,especially in young children,because it not only can correct the deformity but also allows extension along with the children's growth.

PRSS treatment of progressive early onset juvenile scoliosis / 中国矫形外科杂志

0.05)indicating no significant loss of correction.The length of the growth of instrumented spine was 13.3 mm.No sever complications in the series. Conclusion The PRSS which dispenses without bony fusion is a safe and an effective instrumen for management of juvenile scoliosis.It provides and maintains desirable scoliosis correction in one stage procedure,while allowing spinal growth.

Expression and signififcance of IGF-Ⅰ TGF-?1 in human mesenchymal stem cells after exposured to extracoporeal shock wave / 中国矫形外科杂志

[Objective]To demonstrate mechanism of ESW in curing osteogetic disorders,we studied expression of some osteogenetic factors in human mesenchymal stem cells(hMSCs)when exposed to ESW.[Method]After success in marrow aspiration,isolation and obtainment optimal experimental energy,a dose of 5kV and 100 times of ESW was applied to hMSCs of passage 1.The expression of IGF-Ⅰ and TGF-?1 were examined by immunocytochemical staining.[Result]The cytochemical staining results showed that expression of IGF-Ⅰ and TGF-?1 appeared at different passage of hMSCs after ESW intervention.Appearance of IGF-Ⅰ was earlier than TGF-?1 which didnt express until passage 7.At the same interval,the expression of IGF-Ⅰ and TGF-?1 in control group difference is lower than ESW group,respectively(P

Anterior spinal fusion with TSRH instrumentation for scoliosis / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To introduce a new spinal internal fixation system, Texas Scottish Rite Hospital (TSRH), and to investigate its early clinical outcomes.</p><p><b>METHODS</b>The preliminary clinical outcomes of 15 patients with thoracolumbar or lumbar scoliosis treated by anterior spinal fusion with TSRH instrumentation were studied retrospectively. Fourteen patients were diagnosed as idiopathic scoliosis and 1 as neuromuscular scoliosis.</p><p><b>RESULTS</b>Preoperatively, the Cobb's angle on the coronal plane was 55.8 degrees (range 35 degrees to approximately 78 degrees), and 14 degrees postoperatively, with an average correction of 74.8%. The average unfused thoracical curve was 35.9 degrees preoperatively (range 26 degrees to approximately 51 degrees) and 21.8 degrees (10 degrees to approximately 42 degrees) postoperatively, with 40% correction. The sagittal curve of lumbar was kept physiologically, preoperative 27.9 degrees and postoperative 25.7 degrees respectively. The trunk shift was 13.4 mm (5 to approximately 28 mm) preoperatively and 3.5 mm (0 to approximately 7 mm) postoperatively. The averaged apic vertebra derivation was 47.8 mm (21 to approximately 69 mm) before operation and 10.8 mm (3 to approximately 20 mm) after operation. The distance of C7 to center sacrum vertical line (CSVL) was 19.5 mm (16 to approximately 42) preoperatively and 11.3 mm (0 to approximately 32 mm) postoperatively. The apical vertebra rotation was 3 degree in 15 patients preoperatively, and were improved to normal in 10 patients, 1 degree in 4 patients, and 2 degree in 1 patients postoperatively. None had neurological injury and infection. Only 1 patient complained a cool feeling in the low extremity of concave side, and the symptom vanished at 3-month followed up.</p><p><b>CONCLUSION</b>If used appropriately, TSRH anterior spinal system is a good teatment for low thoracic or thoracic lumbar scoliosis.</p>

Surgical treatment of metastatic spinal tumor / 中国医学科学杂志(英文版)

<p><b>OBJECTIVES</b>To evaluate the effect of surgical treatment on metastatic spinal tumor.</p><p><b>METHODS</b>The results of surgical intervention for metastatic spinal tumor of 31 consecutive patients since October 1985 were reviewed.</p><p><b>RESULTS</b>The average survival time was 17.6 months (range from 3 months to 9 years), and 4 patients are still alive with an average survival time of 24.6 months (range, 14 to approximately 84 months). No postoperative complication was noted. The preoperative symptoms were partially relieved and neurological functions were improved after surgery.</p><p><b>CONCLUSION</b>Surgical treatment for metastatic spinal tumor could improve the life quality, but should be adopted cautiously. The surgical procedures such as decompression and internal fixation should be involved only when neurological deficits occurred. The surgery with postoperative complementary therapy may not only improve the life quality, but also extend the patients' life span.</p>

Treatment of infected total knee arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the treatment of infected total knee arthroplasty (TKA).</p><p><b>METHODS</b>Between 1983 and 2000, 6 patients with infection after TKAs were treated, including 2 men and 4 women, aged on average 63 years (44 - 75 years). Initial knee arthroplasty was performed for osteoarthritis in 4 patients and for rheumatoid arthritis in 2 knees. The timing of diagnosis of infection after knee arthroplasty averaged 50 months (range, 1 month-11 years). Simple debridement and antibiotic treatment were prescribed for 3 patients, debridement and one-stage reimplantation for 1, debridement and two-stage reimplantation for 1, and athrodesis for 1.</p><p><b>RESULTS</b>Of the 3 patients with simple debridement, one was cured, one failed but underwent athrodesis later, and one lost to follow up. Two patients with reimplantation were cured and had good function recovery. All of the 6 patients were followed up on average for 4 years. No infection recurred except one who lost to follow-up.</p><p><b>CONCLUSIONS</b>Management of infection after total knee arthroplasty includes antibiotic suppression and debridement with prosthesis retention, insertion of another prosthesis as a one-stage or two-stage exchange technique, knee arthrodesis and amputation. These treatments have specific indications. To treat infection after total knee arthroplasty, suitable method should be taken according to patient's condition. Arthrodesis is the best salvage operation, though it may handicap patients' daily life. Reimplantation of another prosthesis could maintain a functional joint.</p>

Clinical application of the TRAFIX instrumentation in correcting scoliosis / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the results of the TRAFIX instrumentation in correcting scoliosis.</p><p><b>METHODS</b>Since October 1997, 47 patients with scoliosis received spinal fixation with the TRAFIX instrumentation at the Peking Union Medical College Hospital. The average age was 14. 3 years (range 10 to 38 years). There were 27 idiopathic cases, 16 congenital cases, 2 cases with Marfan syndrome and 2 with neurofibromatosis. Twelve of the 47 patients underwent anterior release, while 4 patients received the revision approach. The average follow-up time was 26 months (13 -38 months).</p><p><b>RESULTS</b>The measurements of primary coronal deformity before and after surgery were 74 degrees (50 degrees approximately 115 degrees) and 38.7 degrees (11 approximately 95 degrees), respectively. The average curve correction was 54%. The average number of fused segments was 12.5 (7 approximately 17) vertebrae. The distance between the center of apex and the C7 plumb line was 56.8 mm before surgery (25 approximately 107 mm) and 31 mm after surgery (10 approximately 87 mm).</p><p><b>CONCLUSION</b>The TRAFIX instrumentation provides three-dimensional correction with refinement, convenience and reliable fixation.</p>